{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:27:49Z","timestamp":1792621669672,"version":"4.5.0"},"reference-count":66,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Exclusive breastfeeding is considered the ideal food in the first six months of life; however, paradoxically, vitamin D content in human breast milk is clearly low and insufficient to obtain the recommended intake of 400 IU daily. This article summarizes the extraordinary metabolism of vitamin D during pregnancy and its content in human breast milk. The prevalence of hypovitaminosis D in pregnant women and\/or nursing mothers and its potential maternal\u2013fetal consequences are analyzed. The current guidelines for vitamin D supplementation in pregnant women, nursing mothers, and infants to prevent hypovitaminosis D in breastfed infants are detailed. Low vitamin D content in human breast milk is probably related to active changes in human lifestyle habits (reduced sunlight exposure).<\/jats:p>","DOI":"10.3390\/ijms241511881","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T01:21:27Z","timestamp":1690248087000},"page":"11881","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Pregnancy, Breastfeeding, and Vitamin D"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4628-2213","authenticated-orcid":false,"given":"Teodoro","family":"Dur\u00e1-Trav\u00e9","sequence":"first","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Navarra, 31008 Pamplona, Spain"},{"name":"Navarrabiomed (Biomedical Research Center), 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fidel","family":"Gallinas-Victoriano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Navarra Hospital Complex, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"ref_1","unstructured":"WHO (2022, December 08). Global Strategy on Infant and Young Child Feeding, Document WHA55 A55\/15. Available online: https:\/\/apps.who.int\/gb\/archive\/pdf_files\/WHA55\/ea5515.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.mayocp.2013.05.011","article-title":"Vitamin D for health: A global perspective","volume":"88","author":"Holick","year":"2013","journal-title":"Mayo Clin. Proc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e77539","DOI":"10.7554\/eLife.77539","article-title":"The extraordinary metabolism of vitamin D","volume":"11","author":"Wagner","year":"2022","journal-title":"eLife"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.metabol.2017.10.001","article-title":"Understanding vitamin D metabolism in pregnancy: From physiology to pathophysiology and clinical outcomes","volume":"86","author":"Karras","year":"2018","journal-title":"Metabolism"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1017\/S0965539511000039","article-title":"Vitamin D and human pregnancy","volume":"22","author":"Grayson","year":"2011","journal-title":"Fetal Matern. Med. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2018.11.011","article-title":"Maternal risk factors and newborn infant vitamin D status: A scoping literature review","volume":"63","author":"Sotunde","year":"2019","journal-title":"Nutr. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/mcn.12210","article-title":"Global summary of maternal and newborn vitamin D status\u2014A systematic review","volume":"12","author":"Saraf","year":"2016","journal-title":"Matern. Child Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"van der Pligt, P., Willcox, J., Szymlek-Gay, E.A., Murray, E., Worsley, A., and Daly, R.M. (2018). Associations of maternal vitamin D deficiency with pregnancy and neonatal complications in developing countries: A systematic review. Nutrients, 10.","DOI":"10.3390\/nu10050640"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"f1169","DOI":"10.1136\/bmj.f1169","article-title":"Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: Systematic review and meta-analysis of observational studies","volume":"346","author":"Aghajafari","year":"2013","journal-title":"BMJ"},{"key":"ref_10","first-page":"CD008873","article-title":"Vitamin D supplementation for women during pregnancy","volume":"7","author":"Palacios","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e913","DOI":"10.1542\/peds.2011-3289","article-title":"Circulating 25-Hydroxyvitamin D3 in Pregnancy and Infant Neuropsychological Development","volume":"130","author":"Morales","year":"2012","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/pai.12876","article-title":"Prenatal vitamin D status and respiratory and allergic outcomes in childhood: A meta-analysis of observational studies","volume":"29","author":"Morales","year":"2018","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"179","DOI":"10.3233\/PRM-140287","article-title":"Vitamin D, bone health, and other health benefits in pediatric patients","volume":"7","author":"Palermo","year":"2014","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1542\/peds.2007-1894","article-title":"Vitamin D deficiency in children and its management: Review of current knowledge and recommendations","volume":"122","author":"Misra","year":"2008","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1002\/jbmr.3884","article-title":"Vitamin D metabolism revised: Fall of dogmas","volume":"34","author":"Bouillon","year":"2019","journal-title":"J. Bone Miner Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1210\/jc.2010-2704","article-title":"The 2011 report on dietary intakes for calcium and vitamin D from the Institute of Medicine: What clinicians need to know","volume":"96","author":"Ross","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline","volume":"96","author":"Holick","year":"2011","journal-title":"Med. J. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.beem.2011.06.009","article-title":"Why the minimum desirable serum 25-hydroxyvitamin D level should be 75 nmol\/L (30 ng\/mL)","volume":"25","author":"Vieth","year":"2011","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1002\/jbmr.463","article-title":"Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness","volume":"26","author":"Hollis","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"443","DOI":"10.3390\/nu7010443","article-title":"Regulation of calcitriol byosinthesis and activity: Focus on gestational vitamin D deficiency and adverse pregnancy outcomes","volume":"7","author":"Avila","year":"2015","journal-title":"Nutrients"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"17030","DOI":"10.1038\/boneres.2017.30","article-title":"New insights into the vitamin D requirements during pregnancy","volume":"5","author":"Hollis","year":"2017","journal-title":"Bone Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1152\/physrev.00027.2015","article-title":"Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery","volume":"96","author":"Kovacs","year":"2016","journal-title":"Physiol. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1159\/000508422","article-title":"Early-life effects of vitamin D: A focus on pregnancy and lactation","volume":"76","author":"Wagner","year":"2020","journal-title":"Ann. Nutr. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1089\/bfm.2019.0102","article-title":"Oral vitamin D supplementation to mothers during lactation-effect of 25(OH) D concentration on exclusively breastfed infants at 6 months of age: A randomized double-blind placebo-controlled trial","volume":"15","author":"Trivedi","year":"2020","journal-title":"Breastfeed. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.abb.2012.02.016","article-title":"Extrarenal expression of the 25-hydroxyvitamin D-1-hydroxylase","volume":"523","author":"Adams","year":"2012","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"317","DOI":"10.3389\/fendo.2019.00317","article-title":"Vitamin D binding protein, total and free vitamin D levels in different physiological and pathophysiological conditions","volume":"10","author":"Bikle","year":"2019","journal-title":"Front. Endocrinol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"358","DOI":"10.4103\/2230-8210.95665","article-title":"Calcium and bone disorders in pregnancy","volume":"16","author":"Mahadevan","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11154-017-9414-3","article-title":"Vitamin D administration during pregnancy as prevention for pregnancy, neonatal and postnatal complications","volume":"18","author":"Wagner","year":"2017","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"R107","DOI":"10.1530\/JOE-14-0642","article-title":"Immunological role of vitamin D at the maternal-fetal interface","volume":"224","author":"Tamblyn","year":"2015","journal-title":"J. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.1542\/peds.2014-1860","article-title":"Vitamin D in fetal development: Findings from a birth cohort study","volume":"135","author":"Hart","year":"2015","journal-title":"Pediatrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1038\/ejcn.2016.83","article-title":"Decreased serum vitamin D levels in early spontaneous pregnancy loss","volume":"70","author":"Hou","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3109\/03014460.2014.954616","article-title":"Maternal vitamin D status and infant anthropometry in a US multicentre cohort study","volume":"42","author":"Eckhardt","year":"2015","journal-title":"Ann. Hum. Biol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1080\/10408398.2016.1220915","article-title":"Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review","volume":"58","author":"Agarwal","year":"2018","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1542\/peds.2015-1669","article-title":"Maternal versus infant vitamin D supplementation during lactation: A randomized controlled trial","volume":"136","author":"Hollis","year":"2015","journal-title":"Pediatrics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3945\/ajcn.115.115105","article-title":"Vitamin D content in human breast milk: A 9-mo follow-up study","volume":"103","author":"Streym","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_36","first-page":"13","article-title":"A call to action: Pregnant women indeed require vitamin D supplementation for better health outcomes","volume":"104","author":"Holick","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hollis, B.W., and Wagner, C.L. (2022). Substantial vitamin D supplementation is required during the prenatal period to improve birth outcomes. Nutrients, 14.","DOI":"10.3390\/nu14040899"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2936","DOI":"10.1210\/jc.2018-00109","article-title":"Effectiveness of prenatal vitamin D deficiency screening and treatment program: A stratified randomized field trial","volume":"103","author":"Rostami","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_39","unstructured":"Institute of Medicine (2011). Dietary Reference Intakes for Calcium and Vitamin D, The National Academies Press."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1210\/jc.2013-1154","article-title":"Randomized controlled trial (RCT) of vitamin D supplementation in pregnancy in a population with endemic vitamin D deficiency","volume":"98","author":"Dawodu","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1056\/NEJMoa1800927","article-title":"Vitamin D supplementation in pregnancy and lactation and infant growth","volume":"379","author":"Roth","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1056\/NEJMoa1906137","article-title":"Six-year follow-up of a trial of antenatal vitamin D for asthma reduction","volume":"382","author":"Litonjua","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S2213-8587(18)30153-0","article-title":"Association of preconception serum 25-hydroxyvitamin D concentrations with livebirth and pregnancy loss: A prospective cohort study","volume":"6","author":"Mumford","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2699","DOI":"10.1007\/s00431-021-04030-1","article-title":"The association between vitamin D levels and the clinical severity and inflammation markers in pediatric COVID-19 patients: Single-center experience from a pandemic hospital","volume":"180","author":"Yurdakul","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Mansur, J.L., Oliveri, B., Giacoia, E., Fusaro, D., and Costanzo, P.R. (2022). Vitamin D: Before, during and after pregnancy: Effect on neonates and children. Nutrients, 14.","DOI":"10.3390\/nu14091900"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Domenici, R., and Vierucci, F. (2022). Exclusive breastfeeding and vitamin D supplementation: \u00bfa positive synergistic effect on prevention of childhood infections?. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19052973"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1017\/S000711451700277X","article-title":"Milk vitamin D in relation to the \u2018adequate intake\u2019 for 0\u20136-month-old infants: A study in lactating women with different cultural backgrounds, living at different latitudes","volume":"118","author":"Stoutjesdijk","year":"2017","journal-title":"Br. J. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Tsugawa, N., Nishino, M., Kuwabara, A., Ogasawara, H., Kamao, M., Kobayashi, S., Yamamura, J., and Higurashi, S. (2021). Comparison of vitamin D and 25-hydroxyvitamin D concentrations in human breast milk between 1989 and 2016\u20132017. Nutrients, 13.","DOI":"10.3390\/nu13020573"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"418","DOI":"10.3345\/cep.2021.00444","article-title":"Breastfeeding and vitamin D","volume":"65","author":"Heo","year":"2022","journal-title":"Clin. Exp. Pediatr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.beem.2018.01.007","article-title":"Vitamin D and calcium in the human breast milk","volume":"32","author":"Bae","year":"2018","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1210\/jc.2015-2175","article-title":"Global consensus recommendations on prevention and management of nutritional rickets","volume":"101","author":"Munns","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"353","DOI":"10.3945\/an.111.000950","article-title":"Maternal vitamin D status: Effect on milk vitamin D content and vitamin D status of breastfeeding infants","volume":"3","author":"Dawodu","year":"2012","journal-title":"Adv. Nutr."},{"key":"ref_53","first-page":"377.e1","article-title":"Effects of solar radiation and an update on photoprotection","volume":"92","author":"Garnacho","year":"2020","journal-title":"An. Pediatr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"235035","DOI":"10.1155\/2010\/235035","article-title":"Circulating 25-hydroxyvitamin D levels in fully breastfed infants on oral vitamin D supplementation","volume":"2010","author":"Wagner","year":"2010","journal-title":"Int. J. Endocrinol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e1229","DOI":"10.1542\/peds.2014-2173","article-title":"Optimizing bone health in children and adolescents","volume":"134","author":"Golden","year":"2014","journal-title":"Pediatrics"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/MPG.0b013e31828f3c05","article-title":"Vitamin D in the healthy European paediatric population","volume":"56","author":"Braegger","year":"2013","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_57","first-page":"57.e1","article-title":"Recommended intake of calcium and vitamin D. Positioning of the Nutrition Committee of the AEP","volume":"77","year":"2012","journal-title":"An. Pediatr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13052-018-0488-7","article-title":"Vitamin D in pediatric age: Consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians","volume":"44","author":"Saggese","year":"2018","journal-title":"Ital. J. Pediatr."},{"key":"ref_59","first-page":"Cd013046","article-title":"Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health","volume":"12","author":"Tan","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3109\/09637486.2014.992006","article-title":"Single high dose vitamin D at birth corrects vitamin D deficiency in infants in Mexico","volume":"66","author":"Moodley","year":"2015","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/jpc.13338","article-title":"Vitamin D in newborns. A randomised controlled trial comparing daily and single oral bolus vitamin D in infants","volume":"53","author":"Huynh","year":"2017","journal-title":"J. Paediatr. Child Health"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Dawodu, A., Salameh, K.M., Al-Janahi, N.S., Bener, A., and Elkum, N. (2019). The effect of high-dose postpartum maternal vitamin D supplementation alone compared with maternal plus infant vitamin D supplementation in breastfeeding infants in a high-risk population. a randomized controlled trial. Nutrients, 11.","DOI":"10.3390\/nu11071632"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Corsello, A., Milani, G.P., Giann\u00ec, M.L., Dipasquale, V., Romano, C., and Agostoni, C. (2022). Different vitamin D supplementation strategies in the first years of life: A systematic review. Healthcare, 10.","DOI":"10.3390\/healthcare10061023"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1017\/S0007114516001756","article-title":"Effect of vitamin D supplementation, directly or via breast milk for term infants, on serum 25 hydroxyvitamin D and related biochemistry, and propensity to infection: A randomised placebo-controlled trial","volume":"116","author":"Chandy","year":"2016","journal-title":"Br. J. Nutr."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1089\/bfm.2016.0164","article-title":"Oral supplementation of parturient mothers with vitamin D and its effect on 25OHD status of exclusively breastfed infants at 6 months of age: A double-blind randomized placebo controlled trial","volume":"12","author":"Naik","year":"2017","journal-title":"Breastfeed Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/advances\/nmz098","article-title":"Vitamin D in breastfed infants: Systematic review of alternatives to daily supplementation","volume":"11","author":"Taghivand","year":"2020","journal-title":"Adv. Nutr."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/15\/11881\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:18:20Z","timestamp":1760127500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/15\/11881"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":66,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["ijms241511881"],"URL":"https:\/\/doi.org\/10.3390\/ijms241511881","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,25]]}}}